Provider Demographics
NPI:1669165304
Name:CLIFT, MICHELLE L (DMD)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:CLIFT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3871 E PINON CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3257
Mailing Address - Country:US
Mailing Address - Phone:805-801-4169
Mailing Address - Fax:
Practice Address - Street 1:27371 S 4410 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-7953
Practice Address - Country:US
Practice Address - Phone:918-256-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist